=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447619994
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GERIATRICARE MANAGEMENT, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2016
-----------------------------------------------------
Last Update Date | 02/12/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6422 GROVEDALE DR 202
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22310-2570
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-313-6114
-----------------------------------------------------
Fax | 703-313-7815
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6422 GROVEDALE DRIVE 202
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22310-2534
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-313-6114
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | MRS. STEPHANIE IONEDES THOMOPOULOS
-----------------------------------------------------
Credential | BCD
-----------------------------------------------------
Telephone | 703-313-6114
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HCO16363
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------